Individual
MARY V. WEBB GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-4644
(601) 200-4645
Mailing address
PO BOX 22727, JACKSON, MS 39225-2727
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R851048
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125987
—
MS
Enumeration date
07/11/2006
Last updated
10/13/2017
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